What you can expect from home support services

We also explain why it is important for you to talk to someone about any problems you have with your home support service, and we give two examples of how making a complaint can make a positive difference to home support services.

Home support services

If you receive publicly funded home support services, it is important that you understand who supplies home support services, what your rights are and how the support you need will be planned and delivered.

Who supplies home support services?

Ministry of Health Disability Support Services, district health boards (DHBs) and Accident Compensation Corporation (ACC) usually contract other professional organisations to provide home support services. These other organisations are also called ‘providers’. Most home support service contracts are moving away from fixed tasks and hours to a more flexible approach, working with you to maintain or improve your independence.

What do you get when you start home support services?

If you have been assessed and you are eligible for home support services, you have rights under the Code of Health and Disability Consumers’ Rights 1996 (the Code of Rights). Some forms of home support may not be covered by the Code of Rights, for example, housework such as cleaning. For more information see the Health and Disability Commissioner website.

When your home support service starts, you will receive an information package from the organisation that is providing your home support service. The information package will include contact details for the home support organisation, information about the services that the organisation can provide and how you can raise a concern or make a complaint.

You will also receive an agreement that explains exactly how the organisation will support you. You will work with them to develop a home support plan that is right for you. This home support plan outlines the assistance you will receive and the goals you can work towards to maintain or improve your independence so you can do the things that are important to you. Having an agreed home support plan helps everyone understand what kind of home support you will receive and should avoid problems that can arise if you ask a support worker to do something and they refuse.

While you are developing your home support plan with your organisation, let them know of any preferences you might have, for example, the time of day you would like the home support worker to visit you and your choice of support worker.

Your home support plan should be updated once a year or if your needs change. Even if you only need home support services for a very short time, you should still develop a home support plan with your organisation.

How to involve family in your home support plan

It is a good idea to ask your family, whānau, aiga and friends to be involved in developing your home support plan, especially if you can become easily confused or have difficulty remembering things. Sometimes your family will be the first to notice if your support requirements are changing, and your home support organisation needs to be made aware of any changing requirements as soon as possible.

You can include family, whānau, aiga and friends in your home support services by asking them to:

be involved when any assessments and individualised plans are being completed or reviewed

provide feedback about the services you are receiving, using the organisation’s complaints and compliments system

act as your advocate if you want them to.

How to improve home support services

Home support services are different from most other health and disability services because support workers come into your home, and when they are in your home, they often work by themselves, without anyone to watch what they are doing. There is a high level of trust between you, your home support organisation and the organisation’s workers that the workers provide the right service to support you.

Unless you tell the organisation, or make a complaint when needed, the home support organisation can only rely on their workers’ feedback to know how you are doing and how they can improve their services. You can help the organisation learn more quickly about problems or ways that they can improve the services they provide. There are different ways you can do this. You can:

take part in a home support organisation’s client satisfaction survey

talk with your organisation when you have your annual review

give feedback through the organisation’s complaints and compliments system (eg, suggestions box or forms that can be sent to an organisation at any time)

contact an advocacy or consumer representative group (eg, the Health and Disability Advocacy Service, Age Concern, Grey Power, Carers New Zealand, Alzheimers New Zealand, Deaf Aotearoa New Zealand).

Your home support organisation will use your feedback and complaints to look at your individual situation and work out how they can improve their systems and processes for you and all people receiving services or supports.

How to raise a concern or make a complaint

If you are concerned about, or unhappy with, the care or support you are receiving through a home support organisation, it is important that you talk to someone about it. You can raise a concern or complaint yourself, or you can ask someone else to do so on your behalf, for example, a family member, friend, volunteer, advocate, health professional or carer.

Important: If you are not the person receiving the service, that person needs to know that you are going to raise a concern about their home support services before you do so.

Don’t be reluctant to raise a concern or make a complaint, even if you think it is too small or unimportant. It is important for home support organisations to know about the small problems or issues as well as the big problems. Raising a concern or making a complaint does not mean you are being difficult. Support workers will not necessarily get into trouble if you make a complaint, and services are generally only altered if your needs have changed.

Here are some examples of things you can complain about.

Your support worker being abusive (physical, verbal or emotional).

Your support worker being dishonest.

Your support worker being careless; compromising your safety or the safety of anyone they are working around (eg, by not using equipment properly).

Your support worker consistently managing their time poorly (eg, frequently arriving late at your home or even not turning up at all, without warning or good reason).

Your support worker not respecting your privacy.

Your support worker not respecting your culture or what makes you unique, or behaving inappropriately (eg, saying things or behaving in a way that makes you feel uncomfortable or just doesn’t feel right to you).

Your support worker not supporting you to meet the goals set in your home support plan.

Your home support organisation not providing an alternative support worker when your main support worker can’t be there.

Your home support organisation sending a support worker who isn’t able to do the work.

Poor communication, for example, if you feel you are not able to easily talk to someone at the home support organisation.

Who should you talk to first?

Your home support organisation

It’s best to first raise any concern or complaint with your home support organisation. This gives the organisation the chance to fix the problem and change the way they provide services. The best way to raise a concern or make a complaint is through the organisation’s complaints process.

Start by phoning the home support organisation, for example, the service coordinator who you might have met or spoken with already. If you make a verbal complaint, the person receiving it is responsible for recording this information. Or you could write down your concern or complaint and post or email it to the organisation. If you discuss your concern or complaint with your support worker, it is important that you tell them that you want them to pass on the information to their manager. You might like to make a note of this should the complaint need to be escalated.

Each home support service organisation follows a complaints process set out in the the Code of Rights. This means the organisation will:

work out a way of resolving the issue that is fair, simple, speedy and efficient

acknowledge your complaint in writing within five working days of receiving that complaint, unless your complaint is resolved to your satisfaction within those five days

make sure you know about the complaints procedure, your right to have an advocate and your right to complain to the Health and Disability Commissioner

document the complaint and the actions taken

aim to resolve your complaint within 10 working days of sending you written acknowledgement of the complaint or work out if they need more time to investigate the complaint. (If they need more than 20 working days, they must give you a reason why.)

keep you informed at least once a month on progress to resolve your complaint

provide you with the final outcome, including the decision and any actions they will take.

If you are not satisfied with the outcome of your complaint, you can ask your home support organisation to reconsider, or ask the organisation how you can have their decision reviewed.

Other options

If you do not feel comfortable raising your concern or complaint directly with your home support organisation, you can contact the local Health and Disability Advocacy Service or the organisation that funds the support services you are receiving (your local DHB, ACC or Ministry of Health Disability Support Services). For more information about raising a complaint with Disability Support Services see Contact Disability Support Services. You can also complain directly to the Health and Disability Commissioner.

When another agency receives your complaint, that agency will review the complaint to work out the best way to resolve it. They might ask your home support organisation to try to resolve the complaint themselves and keep the agency informed as they do so; they might decide to refer your complaint to another agency (eg, the Ministry of Health or the Health and Disability Advocacy Service); they might decide to investigate the complaint themselves or they might decide to take no action.

A complaint can result in the home support service organisation:

making a written apology

undertaking specific training

reviewing and changing systems, policies or procedures to improve the way they deliver their support services.

Examples where making a complaint makes a difference

Here are a couple of examples of how making a complaint can make a difference to the home support services you or others receive.

Case 1

Gaelene’s mother Nina receives home support services from a home support organisation. Nina has had the same support worker for over two years, and they have developed a close relationship.

Gaelene helps Nina with her finances each week. One week Nina asks for an extra $150 as she has already spent the week’s money. This is unusual, so Gaelene asks Nina about it. Nina explains that she is worried about her support worker. Over the past few weeks, the support worker had been very stressed and had talked to Nina about how she cannot pay her children’s school fees. Nina had offered to lend the support worker the money to pay the fees, and the support worker had accepted her help. Together, they had worked out how the support worker would repay Nina.

Nina asks Gaelene not to say anything to the support worker or the organisation because she does not want to be responsible for the support worker losing her job when she is already in financial difficulty.

However, it was unprofessional of the support worker to talk with Nina about her own problems, and while Nina willingly loaned the money to the support worker, this is inappropriate and a breach of the support worker’s professional boundaries. Most home support organisations have policies in place to guide support workers and clients about the types of conversations and arrangements that they can or cannot enter into.

Gaelene should make a complaint to the organisation so that the organisation can address the problem. It might not mean the support worker loses their job, but they might be provided with training about how to work within their professional boundaries, and the organisation might support the worker to access appropriate budgeting services. The organisation might also review their policies and training for their staff on professional boundaries, to improve the service they deliver and reduce the chance of other clients being placed in the same situation as Nina.

Case 2

Mary (aged 84) supports her husband Carl (aged 87) at home. For them to remain living at home, Carl needs help doing such things as showering, preparing for bed, getting up and dressing in the morning, etc.

Their regular support worker Angela is an important part of Mary and Carl’s daily life because Mary is not strong enough to provide the level of help Carl needs on her own. She might be injured trying to do these things for Carl, or she might cause him to fall and injure himself.

However, Angela is not always able to get to them on time, and occasionally she arrives very late, causing disruption and stress to Carl and Mary’s daily routines. Mary discusses her concerns with Angela, but the problem is not resolved. Although she is reluctant to ‘dob Angela in’, Mary phones Angela’s supervisor at the organisation that employs her and expresses her concerns. The organisation speaks to Angela who then ensures she always arrives on time to support Carl and Mary.

Also, a plan is put in place so that if there are problems in the future, Mary and Carl can talk again to the supervisor, and a new support worker might be appointed to provide Carl’s support or the roster system might be altered to ensure Angela has more time to arrive at Mary and Carl’s home on time.